Vaccine self-sufficiency through procurement
Some countries have decided to take on more responsibility for purchasing vaccines for the national programmes, either directly from manufacturers or from local representatives of these manufacturers. While this trend is commendable, it should not come at the expense of vaccine quality. Due to the biological nature, the purchase of vaccines is a complex process that requires specialized knowledge in order to ensure vaccine quality and affordable prices. The composition of vaccines is different to drugs in several respects and their procurement requires additional considerations.
There is therefore a growing urgency to offer technical assistance to countries to develop well-functioning procurement systems and to identify more sustainable financing strategies.
Strengthening national procurement
The Department of Immunization, Vaccines and Biologicals (IVB) provides technical expertise to countries to:
- assure that adequate quantities of only high quality and affordable vaccines are purchased by countries to meet their national immunization needs;
- increase capacity building within countries to improve the provision of vaccines, through strategies directed towards more sustainable financing and procurement.
The strategy to achieving the above objectives is based on the following cornerstones:
The purchase of vaccines requires immunization expertise and should be managed by procurement staff with specialized knowledge. Mistakes could have a catastrophic effect on the country. Procurement staff must therefore be aware of the differences between purchasing vaccines and purchasing pharmaceuticals or other commodities.
Purchasing vaccines of quality means that the procurement entity is responsible for ensuring that that vaccines are:
- Safe, potent and effective; and
- Produced under conditions that ensure that each lot is of equally high quality. Since vaccines are subject to lot-to-lot variation, it is insufficient to test samples of the final product and oversight of the entire manufacturing process is required.
Various resources are available to national staff to increase their knowledge base and strengthen their expertise in vaccine procurement.
After more than five years' work, a major reference manual was developed by WHO, BASICS, PATH, USAID, entitled "Procurement of vaccines for public-sector programmes". This manual serves as a comprehensive resource guide for those involved in vaccine procurement by fully explaining key principles of vaccine procurement and offering guidelines on best practice. It provides practical examples and outlines the processes that could be used in the development of an efficient vaccine procurement system. While some of the specific reference documents may have been superseded or updated since its publication these should be available and utilized from the source organization(s).
Assessment of systems
In order to develop effective national systems which procure high-quality vaccines at affordable prices, country governments should be aware of the strengths and weaknesses in their current procurement mechanisms.
A standardized assessment tool has been developed to assess performance in vaccine procurement in key areas of:
- legal infrastructure
- vaccine forecasting
- budgeting and finance
- procurement procedures
- vaccine receipt
- quality assurance issues
WHO HQ and regional offices work together with country offices and health officials to prepare for and conduct a mission of between four and six days including interviews with all effected parties and a full documentation review (some of which is required in advance of the mission).
The debrief session conducted at the conclusion of the mission is an opportunity to identify and discuss the initial findings. A full report with recommendations for further actions is supplied to the WHO Representative to be distributed to the Ministry of Health. This report provides the information needed for the country to draft and institutional plan to strengthen procurement performance.
As part of the Global Training Network (GTN), courses in strengthening vaccine procurement skills are offered several times a year. The objectives of the training are the following:
- To define vaccine procurement requirements in the context of global and national regulations and policies.
- To define key concepts and practical approaches for optimal performance in vaccine procurement.
- To increase knowledge concerning the tools and techniques available to improve vaccine procurement.
- To promote best practice and strategic thinking in regards to vaccine procurement by facilitating information exchange among participants.
The primary audience for this five-day training are relevant technical staff of countries which are currently procuring their vaccines independently or considering transitioning to this system. This can include country representatives who are responsible for managing:
- national supply and procurement procedures
- national immunization programme activities
- national regulation of vaccine quality
The secondary audience are a) technical staff of countries transitioning from using UNICEF supply services to self (or group) procurement or b) agency staff from local offices of WHO, UNICEF and other partner organizations.
Training materials and methodology
This vaccine procurement training programme is adapted from various technical documents of WHO, UNICEF and other partner agencies with expertise in vaccine procurement. Training materials cover 15 modules in four topic 'blocks':
- Block 1: setting the stage, understanding the challenges.
- Block 2: understanding procurement methods and procedures.
- Block 3: vaccine procurement tools and methods.
- Block 4: monitoring performance and building capacity.
Modules can and are adapted for the specific audience attending the training.
Colourful images and humour are used to animate the teaching materials and reinforce concepts that might be unfamiliar. Small group work and hands-on exercises are used to complement theoretical sessions in order to stimulate participation, optimize interaction of trainees, and build upon their existing knowledge and experiences.
Prior to attendance, countries are encouraged to conduct a vaccine procurement assessment to identify the areas of strength and weakness in their systems. In addition preparatory work is required from all participants to familiarize themselves with different aspects of their own systems. Participants complete the training by developing an institutional strengthening plan for their country to improve existing vaccine procurement practices.
Presentation materials, hand-outs and reference documents are provided to participants on a CD at the end of the five-day training.